<p>Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings’ Asking Questions</p>

Abstract

Background: Morning bedside rounds remain an essential part of Internal Medicine residency education, but rounds vary widely in terms of educational value and learner engagement. Objective: To evaluate the efficacy of an intervention to increase the number and variety of questions asked by attendings at the bedside and assess its impact. Design: We conducted a randomized, controlled trial to evaluate the efficacy of our intervention. Participants: Hospitalist attendings on the general medicine service were invited to participate. Twelve hospitalists were randomized to the experimental group and ten hospitalists to the control group. Intervention: A one-hour interactive session which teaches and models the method of asking questions using a non-medical case, followed by practice using role plays with medical cases. Main Measures: Our primary outcome was the number of questions asked by attendings during rounds. We used audio-video recordings of rounds evaluated by blinded reviewers to quantify the number of questions asked, and we also recorded the type of question and the person asked. We assessed whether learners found rounds worthwhile using anonymous surveys of residents, patients, and nurses. Key Results: Blinded analysis of the audio-video recordings demonstrated significantly more questions asked by attendings in the experimental group compared to the control group (mean number of questions 23.5 versus 10.8, p< 0.001) with significantly more questions asked of the residents (p<0.003). Residents rated morning bedside rounds with the experimental attendings as significantly more worthwhile compared to rounds with the control group attendings (p=0.009). Conclusion: Our study findings highlight the benefits of a one-hour intervention to teach faculty a method of asking questions during bedside rounds. This educational strategy had the positive outcome of including significantly more resident voices at the bedside. Residents who rounded with attendings in the experimental group were more likely to "strongly agree" that bedside rounds were "worthwhile".

Assessing “How to Ask Questions” – Response to: Is Asking Questions on Rounds a Teachable Skill? [Letter]

“…We read with interest Shields’s article 1 that evaluated the impact of teaching attendings how to ask their colleagues questions during bedside rounds. The authors stated that this had the potential to increase the engagement of multidisciplinary team members and learning opportunities.…”

“…Meanwhile, residents in the experimental group rated the rounds significantly higher. 1 In future research, the authors could consider using the audio-visual recordings of rounds to assess the appropriateness of attendings’ questions to the role of each team member.…”

“…Free text answers from the surveys showed that some residents would have preferred attendings to not “judge incorrect answers” or “[encourage] questions from students” which could allude to residents’ poor engagement. 1 …”

A Response to “Is Asking Questions on Rounds a Teachable Skill? A Randomized Controlled Trial to Increase Attendings’ Asking Questions” – A Medical Student Perspective [Letter]

“…We read with interest the article by Shields et al 1 in which they discussed the results of teaching students an effective way of asking questions in a ward round. They implemented the famous “question listen respond” strategy, which is an engagement method used in business and law.…”

Is Asking Questions on Rounds a Teachable Skill?[Response to Letter]

“…A randomized controlled trial to increase attendings' asking questions." 1 We agree that in our future research into the use of questions on bedside rounds, we will utilize their excellent suggestion of audio-video recordings of attending bedside rounds to evaluate the alignment of the attendings' questions with the specific role of each team member.…”